Provider Demographics
NPI:1447690219
Name:KLAY, JILL MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:KLAY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 HUMES ROAD
Mailing Address - Street 2:T-0809
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0204
Mailing Address - Country:US
Mailing Address - Phone:608-757-0834
Mailing Address - Fax:608-302-4351
Practice Address - Street 1:2017 HUMES ROAD
Practice Address - Street 2:T-0809
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0204
Practice Address - Country:US
Practice Address - Phone:608-757-0834
Practice Address - Fax:608-302-4351
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15043-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist